Wound care
Diabetic Foot & Chronic Wounds
Non-healing wounds, diabetic foot ulcers and limb salvage in Singapore — where wound care and blood-flow assessment happen together.
Last reviewed 30 Jun 2026
Reviewed by Dr Tay Jia Sheng · Vascular, Endovascular & General Surgeon
Why wounds fail to heal
A wound that has not begun healing within two weeks has a reason. In the leg and foot, the usual culprits are:
- Poor arterial supply — narrowed leg arteries starve the wound of the blood it needs to heal
- Diabetes — nerve damage (neuropathy) means injuries go unnoticed, while small- and large-vessel disease slows healing and invites infection
- Venous hypertension — leaking vein valves cause the ulcers that form around the ankle
- Pressure — over bony points in patients with limited mobility
Dressings treat the surface. Unless the underlying cause is identified and corrected, the wound persists — which is why chronic wounds need vascular assessment alongside good wound care.
Diabetic foot: the stakes
For a person with diabetes in Singapore, a foot ulcer is a limb-threatening event, not a skin complaint. Infection can spread quickly in a foot with poor sensation and poor blood flow, and delayed treatment is the common path to amputation. The reverse is also true: assessed early, many diabetic foot wounds can be healed and many amputations prevented — this is what limb salvage means in practice.
How I assess a chronic wound
- Clinical assessment of the wound, sensation and pulses
- Arterial and venous duplex ultrasound at the same visit — mapping blood supply and drainage
- Targeted imaging (CT or catheter angiography) where revascularisation is being planned
- Assessment of infection, including bone involvement where suspected
Treatment: restore flow, then heal the wound
- Revascularisation — reopening blocked leg arteries with angioplasty, atherectomy and stenting, or bypass surgery where endovascular options are unsuitable; adequate blood flow is the foundation the other measures depend on
- Debridement and wound bed preparation — removing dead tissue so healthy tissue can close
- Infection control — antibiotics, drainage and surgery as needed
- Offloading and footwear — removing the pressure that created the wound
- Compression therapy for venous ulcers once arterial supply is confirmed
- Ongoing surveillance — healed diabetic feet remain at-risk feet; regular review is how a new problem is caught early
When to see a doctor promptly
Any foot wound in a person with diabetes; any wound anywhere that has not started healing in two weeks; spreading redness, warmth or odour; new foot pain at rest, or a foot that turns pale or cold. In a compromised foot, days change outcomes.
Reference: Treatment of lower limb ischaemia in patients with diabetes. Diabetes/Metabolism Research and Reviews 2020;36(S1):e3262.
Frequently asked questions
- How long should I wait before a wound is considered a problem?
- Two weeks. A wound that has not begun healing within two weeks has a reason — poor arterial supply, diabetes, venous hypertension or pressure — and dressings alone will not resolve it until that reason is identified and corrected.
- Why is a foot ulcer so serious for someone with diabetes?
- Because it is a limb-threatening event, not a skin complaint. Nerve damage means injuries go unnoticed, small- and large-vessel disease slows healing, and infection can spread quickly in a foot with poor sensation and poor blood flow. Delayed treatment is the common path to amputation; early assessment is how many of those amputations are prevented.
- What does limb salvage mean?
- Restoring enough blood flow to a threatened foot that the wound can heal and the limb can be kept, rather than amputated. In practice it combines reopening blocked arteries — by angioplasty, atherectomy and stenting, or bypass where those are unsuitable — with wound care, infection control and offloading.
- What happens at the first assessment?
- Clinical assessment of the wound, sensation and pulses, together with arterial and venous duplex ultrasound at the same visit, so blood supply and drainage are mapped before any plan is made. Targeted imaging follows where revascularisation is being planned, and infection is assessed, including the bone where that is suspected.
- Once a diabetic foot wound has healed, is the problem over?
- No. A healed diabetic foot remains an at-risk foot. Regular review, appropriate footwear and prompt attention to any new wound are the measures that help keep it healed — surveillance is part of the treatment, not an afterthought.